23-1062.02. Off-label and prescription use of controlled substances; prescription of schedule II controlled substances; reports; treatment plans; monitoring program inquiries; preauthorizations; definitions
A. A physician shall include in the report required under commission rule information pertaining to the following:
1. The off-label use of a narcotic, opium-based controlled substance or schedule II controlled substance by a claimant.
2. The use of a narcotic or opium-based controlled substance or the prescription of a combination of narcotics or opium-based controlled substances at or exceeding a one hundred twenty milligram morphine equivalent dose per day.
3. The prescription of a long-acting or controlled release opioid for acute pain.
B. The information required pursuant to subsection A of this section shall include the justification for use of the controlled substance, and a treatment plan that includes a description of measures that the physician will implement to monitor and prevent the development of abuse, dependence, addiction or diversion by the employee. The physician shall include in the treatment plan a medication agreement, a plan for subsequent follow-up visits and random drug testing and documentation that the medication regime is providing relief that is demonstrated by clinically meaningful improvement in function. If the drug test of the employee reveals inconsistent results, the physician within five business days shall provide a written report to the carrier, self-insured employer or commission setting forth a treatment plan to address the inconsistent drug test results.
C. Within two business days of writing or dispensing an initial prescription order for at least a thirty-day supply of an opioid medication for the employee, a physician shall submit an inquiry to the Arizona state board of pharmacy requesting the employee's prescription information that is compiled under the controlled substances prescription monitoring program prescribed in title 36, chapter 28. The physician shall report the results to the carrier, self-insured employer or commission as soon as reasonably practicable but no later than thirty days from the date of the inquiry. Thereafter, the carrier, self-insured employer or commission may request no more than once every two months that the physician perform additional inquiries to the Arizona state board of pharmacy.
D. If the result of an inquiry to the Arizona state board of pharmacy reveals that the employee is receiving opioids from another undisclosed health care provider, the physician shall within five business days report the results to the carrier, self-insured employer or commission.
E. If the physician does not comply with this section:
1. The carrier, self-insured employer or commission is not responsible for payment for the physician's services until the physician complies with this section.
2. Except for a self-insured employer that provides medical care pursuant to section 23-1070, an employer, carrier or commission may request a change of physician after making a written request to the physician to comply with this section and the request identifies the area of noncompliance. If a change of physician is ordered and the order becomes final, the employee shall select a physician whose practice includes pain management and who agrees to comply with this section. If other medical providers are not available in the employee's area of residence, the employer, carrier or commission shall pay in advance for the employee's reasonable travel expenses, including the cost of transportation, food, lodging and loss of pay, if applicable.
F. If medically necessary, the carrier, self-insured employer or commission shall provide drug rehabilitation and detoxification treatment for an employee who becomes dependent on or addicted to opioids that are prescribed for a work-related injury. In the event of a medical conflict regarding the necessity for drug rehabilitation and detoxification, the carrier, self-insured employer or commission shall continue to provide the opioids until a determination is made after a hearing by an administrative law judge.
G. If the employee resides out of state, the carrier, self-insured employer or commission may not be responsible for providing medications that are subject to this section if the out-of-state physician fails to comply with this section. If the other state has a controlled substances monitoring program, the physician shall submit an inquiry to the database as prescribed by subsection C of this section.
H. This section does not apply to medications administered to the employee while the employee is receiving inpatient hospital treatment.
I. A carrier, self-insured employer or commission may require physician compliance with this section notwithstanding the existence of a prior award addressing medical maintenance benefits for medications. A carrier or self-insured employer is not liable for bad faith or unfair claims processing for any act taken in compliance of and consistent with this section.
J. For the purposes of this section:
1. " Clinically meaningful improvement in function" means any of the following:
(a) A clinically documented improvement in range of motion.
(b) An increase in the performance of activities of daily living.
(c) A return to gainful employment.
2. " Inconsistent results" means:
(a) The employee's reported medications, including the parent drugs or metabolites, are not detected.
(b) Controlled substances are detected that are not reported by the employee.
3. " Off-label use" means use of a prescription medication by a physician to treat a condition other than the use for which the drug was approved by the United States food and drug administration.
Section: Previous 23-1046 23-1047 23-1048 23-1061 23-1061.01 23-1062 23-1062.01 23-1062.02 23-1062.03 23-1063 23-1064 23-1065 23-1066 23-1067 23-1068 NextLast modified: October 13, 2016